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Left atrial pressure is associated with iatrogenic atrial septal defect after mitral valve clip
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  • Omar Abdul-Jawad Altisent, Victoria Vilalta, Eduard Fernandez-Nofrerias, Evelyn Santiago, Roger Villuendas, Gladys Junca, Francisco Gual, Xavier Carrillo, Oriol Rodrigez-Leor, Josefina Mauri, Josep Lupon and Antoni Bayés-Genís
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    Iatrogenic atrial septal defect: size matters
    • Omar Abdul-Jawad Altisent, Interventional cardiologist MD, PhD, Germans Trias i Pujol University Hospital (Barcelona, Spain)
    • Other Contributors:
      • Victoria Vilalta, Interventional cardiologist
      • Eduard Fernandez-Nofrerias, Interventional Cardiologist
      • Evelyn Santiago, Cardiologist
      • Roger Villuendas, Cardiologist
      • Gladys Junca, Cardiologist
      • Francisco Gual, Cardiologist
      • Xavier Carrillo, Interventional cardiologist
      • Oriol Rodrigez-Leor, Interventional Cardiologist
      • Josefina Mauri, Interventional cardiologist
      • Josep Lupon, Cardiologist
      • Antoni Bayés-Genís, Cardiologist

    To the Editor,
    We read with interest the paper by Ikenaga et al. (1), who must be commended for their detailed report on the determinants of persistent iatrogenic atrial septal defect (iASD) following percutaneous mitral valve clip (MV clip) placement. The authors found that elevated left atrial (LA) pressure after the MV clip procedure was the main determinant of persistent iASD during follow-up. Remarkably, in spite of their poorer clinical condition, patients with and without persistent iASD had similar outcomes during follow-up. This suggested that interatrial shunt has a benefit in some MV clip patients. Previous studies that evaluated the usefulness of an interatrial shunt device for treating heart failure patients without valve disease also showed a significant benefit of the shunt in patients with high LA pressure (2, 3).
    However, these findings disagree with other findings of the persistence of iASD after MV clip placement with negative outcomes, mainly due to right ventricle (RV) claudication (4). Indeed, previous studies of the interatrial shunt device suggest that the size of the shunt plays a key role in outcomes. Indeed, the ideal shunt size should allow the reduction of LA pressure without hampering right heart function. The maximum interatrial shunt devices are 5 mm2 (3); too large iASDs may increase the Qp/Qs enough to cause RV failure, while too small iASDs may be have negligible hemodynamical and clinical results. No MV clip studies reported...

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    Conflict of Interest:
    None declared.